Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8124-8132
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8124
Distinctive clinical features of spontaneous pneumoperitoneum in neonates: A retrospective analysis
Soo-Hong Kim, Yong-Hoon Cho, Hae-Young Kim
Soo-Hong Kim, Yong-Hoon Cho, Hae-Young Kim, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, South Korea
Yong-Hoon Cho, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
Author contributions: Cho YH and Kim SH contributed to study conception and design, drafting and revision of the manuscript, and finalization of the submission; Kim HY contributed to data analysis and interpretation; All authors reviewed the final manuscript.
Supported by A 2-Year Research Grant of Pusan National University, No. 201812270003.
Institutional review board statement: This study was reviewed and approved by the Pusan National University Yangsan Hospital Institutional Review Board also approved to progress this project without informed consent, No. 05-2020-044.
Informed consent statement: This study is a retrospective cohort study. Therefore, it was impossible to get consent from patients and their guardians in advance. This study was not for research purpose about human subject itself, so it does not contain any concerned data. It may be published as a journal worthy of being open in public after collecting data of managements for the past 12 years. Moreover, Pusan National University Yangsan Hospital Institutional Review Board also approved to carry out this project without informed consent
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: No additional data are available. All data relevant to the study are included in the article and are also available upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Hoon Cho, MD, Professor, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumo-ro 20, Mulgeumeup, Yangsan 50612, South Korea. choyh70@pusan.ac.kr
Received: December 17, 2021
Peer-review started: December 17, 2021
First decision: February 21, 2022
Revised: March 2, 2022
Accepted: June 30, 2022
Article in press: June, 30, 2022
Published online: August 16, 2022
Processing time: 227 Days and 2.5 Hours
Abstract
BACKGROUND

Spontaneous pneumoperitoneum (SP) without gastrointestinal perforation rarely occurs in neonates, with most SP cases being idiopathic. Although SP usually follows a benign clinical course with favorable prognosis, it can become life-threatening in certain situations. In these cases, urgent surgical intervention may be required. Therefore, it may be difficult to decide when or how to perform prompt interventions.

AIM

To demonstrate the distinct clinical features of SP to guide appropriate management by comparing characteristics between SP and typical pneumoperitoneum secondary to gastrointestinal perforation.

METHODS

We retrospectively reviewed electronic medical records and identified 37 neonates with radiological evidence of pneumoperitoneum who were treated at our institution. Clinical variables were compared between neonates with SP without gastrointestinal perforation (Group A) and those with pneumoperitoneum secondary to gastrointestinal perforation (Group B). Clinical variables between groups were compared using Student’s t-test and the chi-square test. The risk factors related to mortality were examined using multi-logistic regression analysis.

RESULTS

Group A comprised 35.1% (13/37) of the patients. The frequency of persistent pulmonary hypertension (53.8%) and pneumothorax (46.2%) before the development of pneumoperitoneum was significantly higher in group A than in group B (P = 0.004). Platelet count and partial pressure of arterial oxygen (PaO2) were significantly lower in group A (P = 0.015 and 0.025, respectively). Overall mortality was significantly higher in group A than in group B (76.9% vs 16.7%, P = 0.001). Only preterm infants were significantly associated with high mortality (P = 0.041; odds ratio = 18.0). Accompaniment with persistent pulmonary hypertension and pneumothorax were also significantly high (P = 0.004) in group A, but these were not strongly associated with high mortality.

CONCLUSION

This study identified a higher mortality rate in patients with SP than that described in previous reports. Neonates with SP were more likely to have thrombocytopenia, pneumothorax, and persistent pulmonary hypertension. Prematurity was the most significant factor affecting mortality.

Keywords: Spontaneous pneumoperitoneum; Thrombocytopenia; Persistent pulmonary hypertension; Pneumothorax; Preterm

Core Tip: This study shows a higher mortality rate in a spontaneous pneumoperitoneum (SP) group than pneumoperitoneum secondary to gastrointestinal perforation, contrary to previous studies. Additionally, neonates with SP were more likely to have thrombocytopenia and accompany pneumothorax and persistent pulmonary hypertension. Preterm infants were the most significant factor affecting its mortality. These distinctive clinical features should be considered in the management of SP.